Long Term Follow-up of Cushing's Disease Treated with Reserpine and Pituitary Irradiation Followed by Subtotal Adrenalectomy.

Murayama, Masanori; Minamori, Yoshiaki; Mercado-Asis, Leilani B.; Yamakita, Noriyoshi; Morita, Hiroyuki; Miura, Kiyoshi

doi:10.1620/tjem.172.97

Cited by 2 publications

(1 citation statement)

References 22 publications

(21 reference statements)

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“…Going forward through the years, with the invention of the new treatment options, the risks of the BA prevailed the benefits and it was gradually replaced from its role as a first-line treatment by the pituitary radiotherapy [20,21]. Medical treatment options for hypercortisolism also appeared on the pharmaceutical market and were used as an adjuvant therapy while awaiting the effect of RT to occur.…”

Section: Cushing's Disease (Cd)mentioning

confidence: 99%

Cushing’s Syndrome: A Historic Review of the Treatment Strategies and Corresponding Outcomes in a Single Tertiary Center over the Past Half-Century

et al. 2018

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Cushing's syndrome (CS) is associated with serious comorbidities and an increased mortality rate that could be reduced only if strict biochemical control is achieved. The aim of this study was to show the 50-year experience of a single tertiary center in the management of CS patients - the different treatment modalities used over the years and the corresponding outcomes. It was a retrospective study of a large cohort of patients from the Bulgarian CS database: 613 patients (374 with ACTH-dependent and 239 with ACTH-independent CS). Pituitary surgery was applied to 242 patients with Cushing's disease (CD) with initial remission rate of 74% of which 10% relapsed. Approximately 36% manifested with active disease during the long-term follow-up (26% with persistent disease, 10% relapses) most of which were subjected to a secondary treatment (13.6% to pituitary resurgery, 14% to pituitary radiotherapy, and 5.4% to bilateral adrenalectomy). A total of 294 CD patients received medical therapy with overall remission rates for the most commonly used drugs: dopamine agonists 20%, pasireotide 30%, and ketoconazole 63%. Significant improvement of results was achieved by combining drugs with different mechanisms of action. Regardless of the progress in the neurosurgery and radiotherapy techniques and new drugs discovery, the management of patients with CS remains a real challenge for physicians. Not only patients with adrenal carcinoma but also significant percentage of subjects with persistent and recurrent Cushing's disease often require a polymodal approach and the efforts of a multidisciplinary highly qualified, experienced, and motivated team in order to achieve a long-term remission.

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Section: Cushing's Disease (Cd)mentioning

confidence: 99%

Cushing’s Syndrome: A Historic Review of the Treatment Strategies and Corresponding Outcomes in a Single Tertiary Center over the Past Half-Century

et al. 2018

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Effect of Pioglitazone on Adrenocorticotropic Hormone and Cortisol Secretion in Cushing’s Disease

Suri¹,

Weiss²

2005

The Journal of Clinical Endocrinology & Metabolism

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The lack of an effective medical therapy for patients with Cushing's disease (CD) requires the search for new modalities of treatment. Peroxisomal proliferator-activated receptors (PPAR)-gamma are abundantly expressed in ACTH-secreting pituitary tumors. Treatment with PPARgamma agonists inhibits ACTH-secreting pituitary tumor growth, proliferation, and ACTH secretion in vitro in human and murine models and in vivo in murine corticotroph tumors. It was hypothesized that treatment with the PPARgamma agonist pioglitazone would normalize the hypothalamic-pituitary-adrenal axis of patients with CD. We evaluated the hypothalamic pituitary adrenal axis in five patients with CD in whom we measured: 1) the 24-h urine concentration of free cortisol; 2) the 24-h profile of serum cortisol and plasma ACTH; and 3) the ACTH and cortisol response to CRH stimulation. All measurements were taken at baseline and after low-dose dexamethasone treatment (0.5 mg dexamethasone every 6 h). The entire protocol was done before and after 30 d of treatment with 45 mg of daily oral pioglitazone. At baseline, before low-dose dexamethasone, all five patients had elevated 24-h urine free cortisol, elevated 24-h serum cortisol and plasma ACTH levels, and robust responses to CRH, consistent with their diagnosis of CD. There was no significant change in any of the above variables after 30 d of treatment with pioglitazone. Furthermore, there was no significant difference in the number of cortisol or ACTH spikes or in their diurnal rhythms. In summary, pioglitazone treatment (45 mg daily for 30 d) of patients with CD was not found to be effective at attenuating either ACTH or cortisol levels and does not appear to be an alternative to surgical therapy.

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Long Term Follow-up of Cushing's Disease Treated with Reserpine and Pituitary Irradiation Followed by Subtotal Adrenalectomy.

Cited by 2 publications

References 22 publications

Cushing’s Syndrome: A Historic Review of the Treatment Strategies and Corresponding Outcomes in a Single Tertiary Center over the Past Half-Century

Cushing’s Syndrome: A Historic Review of the Treatment Strategies and Corresponding Outcomes in a Single Tertiary Center over the Past Half-Century

Effect of Pioglitazone on Adrenocorticotropic Hormone and Cortisol Secretion in Cushing’s Disease

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